Les réponses des membres inférieurs à des translations médio-latérales imprévues pendant le mouvement de pédalage

Les perturbations vers la gauche ou vers la droite sont des occurrences quasi-quotidiennes pour un bon nombre de gens. Se faire bousculer en marchant dans la foule ou subir les effets inertiels d'un véhicule de transport en commun tournant ou s'arrêtant soudainement ne sont que deux exemples communs de telles situations. De plus, les perturbations dues aux glissements latéraux sont fréquemment observées chez les personnes âgées. Les articulations des membres inférieurs et du tronc ont moins de latitude de mouvement dans le plan frontal que dans le plan sagittal. En conséquence, lors d'une translation médio-latérale inattendue le système nerveux central (SNC) utilise probablement des stratégies compensatoires différentes du cas de la direction antéro-postérieure. Le but de cette étude était d'évaluer les stratégies compensatoires utilisées lors de perturbations perpendiculaires au plan du mouvement. Un vélo ergométrique modifié fut utilisé comme modèle de mouvements rythmiques; dans une telle situation, les effets de l'équilibre sont de beaucoup amoindris et les réactions compensatoires peuvent être attribuées à la perturbation du mouvement rythmique. Pour les fins de cette étude les sujets eurent à pédaler sous quatre conditions expérimentales différentes: dynamique active (DA), au cours de laquelle les sujets pédalaient à une fréquence de 1 Hz maintenue à l'aide d'un métronome et d'information présentée sur un écran d'ordinateur; dynamique passive (DP), au cours de laquelle les mouvements enregistrés sous la condition DA étaient reproduits à l'aide d'un moteur dynamométrique tandis que les sujets devaient simplement relaxer; statique active (SA), au cours de laquelle chaque sujet devait essayer de reproduire l'activité musculaire produite par leur soléaire sous la condition DA; statique passive (SP), au cours de laquelle les sujets devaient simplement maintenir chacune des positions du cycle de pédalage tout en relaxant. Des mouvements vers la gauche et vers la droite d'à peu près 1 g (9.8 ms-2) d'accélération furent appliqués aléatoirement à l'aide d'un cylindre électrique pendant une des quatre phases du cycle de pédalage: propulsion (P), récupération (R), transition PR, et transition RP. L'activité électromyographique (EMG) du soléaire (SOL), du médial du gastrocnémien (MG), du tibial antérieur (TA), du vaste latéral (VL), du biceps fémoral [chef court] (BF), et du tenseur du fascia lata (TFL) furent enregistrés et analysés. Les réponses EMG furent divisées en deux époques (E) selon la latence de la réponse:

Self-Paced Reaching after Stroke: A Quantitative Assessment of Longitudinal and Directional Sensitivity Using the H-Man Planar Robot for Upper Limb Neurorehabilitation

Hussain A, Budhota A, Hughes CML, et al. Self-Paced Reaching after Stroke: A Quantitative Assessment of Longitudinal and Directional Sensitivity Using the H-Man Planar Robot for Upper Limb Neurorehabilitation. Frontiers in Neuroscience. 2016;10:477

Comparison of Robotics, Functional Electrical Stimulation, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction After Stroke: A Randomized Controlled Trial

Objective To compare response to upper-limb treatment using robotics plus motor learning (ML) versus functional electrical stimulation (FES) plus ML versus ML alone, according to a measure of complex functional everyday tasks for chronic, severely impaired stroke survivors. Design Single-blind, randomized trial. Setting Medical center. Participants Enrolled subjects (N=39) were \u3e1 year post single stroke (attrition rate=10%; 35 completed the study). Interventions All groups received treatment 5d/wk for 5h/d (60 sessions), with unique treatment as follows: ML alone (n=11) (5h/d partial- and whole-task practice of complex functional tasks), robotics plus ML (n=12) (3.5h/d of ML and 1.5h/d of shoulder/elbow robotics), and FES plus ML (n=12) (3.5h/d of ML and 1.5h/d of FES wrist/hand coordination training). Main Outcome Measures Primary measure: Arm Motor Ability Test (AMAT), with 13 complex functional tasks; secondary measure: upper-limb Fugl-Meyer coordination scale (FM). Results There was no significant difference found in treatment response across groups (AMAT: P≥.584; FM coordination: P≥.590). All 3 treatment groups demonstrated clinically and statistically significant improvement in response to treatment (AMAT and FM coordination: P≤.009). A group treatment paradigm of 1:3 (therapist/patient) ratio proved feasible for provision of the intensive treatment. No adverse effects. Conclusions Severely impaired stroke survivors with persistent (\u3e1y) upper-extremity dysfunction can make clinically and statistically significant gains in coordination and functional task performance in response to robotics plus ML, FES plus ML, and ML alone in an intensive and long-duration intervention; no group differences were found. Additional studies are warranted to determine the effectiveness of these methods in the clinical setting

Technology-assisted stroke rehabilitation in Mexico: a pilot randomized trial comparing traditional therapy to circuit training in a Robot/technology-assisted therapy gym

Background Stroke rehabilitation in low- and middle-income countries, such as Mexico, is often hampered by lack of clinical resources and funding. To provide a cost-effective solution for comprehensive post-stroke rehabilitation that can alleviate the need for one-on-one physical or occupational therapy, in lower and upper extremities, we proposed and implemented a technology-assisted rehabilitation gymnasium in Chihuahua, Mexico. The Gymnasium for Robotic Rehabilitation (Robot Gym) consisted of low- and high-tech systems for upper and lower limb rehabilitation. Our hypothesis is that the Robot Gym can provide a cost- and labor-efficient alternative for post-stroke rehabilitation, while being more or as effective as traditional physical and occupational therapy approaches. Methods A typical group of stroke patients was randomly allocated to an intervention (n = 10) or a control group (n = 10). The intervention group received rehabilitation using the devices in the Robot Gym, whereas the control group (n = 10) received time-matched standard care. All of the study subjects were subjected to 24 two-hour therapy sessions over a period of 6 to 8 weeks. Several clinical assessments tests for upper and lower extremities were used to evaluate motor function pre- and post-intervention. A cost analysis was done to compare the cost effectiveness for both therapies. Results No significant differences were observed when comparing the results of the pre-intervention Mini-mental, Brunnstrom Test, and Geriatric Depression Scale Test, showing that both groups were functionally similar prior to the intervention. Although, both training groups were functionally equivalent, they had a significant age difference. The results of all of the upper extremity tests showed an improvement in function in both groups with no statistically significant differences between the groups. The Fugl-Meyer and the 10 Meters Walk lower extremity tests showed greater improvement in the intervention group compared to the control group. On the Time Up and Go Test, no statistically significant differences were observed pre- and post-intervention when comparing the control and the intervention groups. For the 6 Minute Walk Test, both groups presented a statistically significant difference pre- and post-intervention, showing progress in their performance. The robot gym therapy was more cost-effective than the traditional one-to-one therapy used during this study in that it enabled therapist to train up to 1.5 to 6 times more patients for the approximately same cost in the long term. Conclusions The results of this study showed that the patients that received therapy using the Robot Gym had enhanced functionality in the upper extremity tests similar to patients in the control group. In the lower extremity tests, the intervention patients showed more improvement than those subjected to traditional therapy. These results support that the Robot Gym can be as effective as traditional therapy for stroke patients, presenting a more cost- and labor-efficient option for countries with scarce clinical resources and funding. Trial registration ISRCTN98578807

Robot Assisted Training for the Upper Limb after Stroke (RATULS): study protocol for a randomised controlled trial.

BACKGROUND: Loss of arm function is a common and distressing consequence of stroke. We describe the protocol for a pragmatic, multicentre randomised controlled trial to determine whether robot-assisted training improves upper limb function following stroke. METHODS/DESIGN: Study design: a pragmatic, three-arm, multicentre randomised controlled trial, economic analysis and process evaluation. SETTING: NHS stroke services. PARTICIPANTS: adults with acute or chronic first-ever stroke (1 week to 5 years post stroke) causing moderate to severe upper limb functional limitation. Randomisation groups: 1. Robot-assisted training using the InMotion robotic gym system for 45 min, three times/week for 12 weeks 2. Enhanced upper limb therapy for 45 min, three times/week for 12 weeks 3. Usual NHS care in accordance with local clinical practice Randomisation: individual participant randomisation stratified by centre, time since stroke, and severity of upper limb impairment. PRIMARY OUTCOME: upper limb function measured by the Action Research Arm Test (ARAT) at 3 months post randomisation. SECONDARY OUTCOMES: upper limb impairment (Fugl-Meyer Test), activities of daily living (Barthel ADL Index), quality of life (Stroke Impact Scale, EQ-5D-5L), resource use, cost per quality-adjusted life year and adverse events, at 3 and 6 months. Blinding: outcomes are undertaken by blinded assessors. Economic analysis: micro-costing and economic evaluation of interventions compared to usual NHS care. A within-trial analysis, with an economic model will be used to extrapolate longer-term costs and outcomes. Process evaluation: semi-structured interviews with participants and professionals to seek their views and experiences of the rehabilitation that they have received or provided, and factors affecting the implementation of the trial. SAMPLE SIZE: allowing for 10% attrition, 720 participants provide 80% power to detect a 15% difference in successful outcome between each of the treatment pairs. Successful outcome definition: baseline ARAT 0-7 must improve by 3 or more points; baseline ARAT 8-13 improve by 4 or more points; baseline ARAT 14-19 improve by 5 or more points; baseline ARAT 20-39 improve by 6 or more points. DISCUSSION: The results from this trial will determine whether robot-assisted training improves upper limb function post stroke. TRIAL REGISTRATION: ISRCTN, identifier: ISRCTN69371850 . Registered 4 October 2013

Comparative study of actuation systems for portable upper limb exoskeletons.

During the last two decades, a large variety of upper limb exoskeletons have been developed. Out of these, majority are platform based systems which might be the reason for not being widely adopted for post-stroke rehabilitation. Despite the potential benefits of platform-based exoskeletons as being rugged and reliable, stroke patients prefer to have a portable and user-friendly device that they can take home. However, the types of actuator as well as the actuation mechanism used in the exoskeleton are the inhibiting factors why portable exoskeletons are mostly non-existent for patient use. This paper presents a quantitative analysis of the actuation systems available for developing portable upper arm exoskeletons with their specifications. Finally, it has been concluded from this research that there are not many stand-alone arm exoskeletons which can provide all forms of rehabilitation, therefore, a generic solution has been proposed as the rehabilitation strategy to get best out of the portable arm exoskeletons